Clinical Evidence Of Heart Disease Research Articles

Early diagnosis of subclinical left ventricular dysfunction in postmenopausal women with rheumatoid arthritis.

Heart failure is the most frequent cause of death among patients affected by rheumatoid arthritis(RA), in which high prevalence is independent of traditional risk factors. An early diagnosis of subclinical heart failure may be made by assessing left ventricular diastolic dysfunction (LVDD) by Doppler Echocardiography. Our study aims to early identify LVDD in RA patients. We enrolled 207 consecutive postmenopausal women (PMW) with normal electrocardiography and physical examination with a confirmed diagnosis of RA, for over one year, 200 PMW free from RA served as the control group (CG). All women underwent M-mode and two-dimensional Doppler echocardiography. A total of 72 women were affected by LVDD among 207 women with RA (34.8%), 46 among 200 women in the CG (23%), chi-squared 6.8, OR 1.8, confidence interval (CI) 95%, p < 0.009. For our RA women, the chance of being affected by LVDD has almost doubled. There were 70 women affected by LVDD among 72 hypertensive women with RA (97.2%). A total of 32 women were affected by LVDD among 98 hypertensive women in the CG (32.7%), chi-squared 72.1, OR 7.2, CI 95%, p < 0.009. Among hypertensive PMW in our population, the chance of being affected by LVDD has more than tripled. All LVDD subjects had abnormal diastolic function for all different degrees. We propose that PMW, affected by RA, have a significantly higher prevalence than CG of LVDD without clinical evidence of heart disease. Since the prevalence is even higher if they are hypertensive, we suggest a Doppler echocardiography examination for all women with a diagnosis of RA.

4 Early diagnosis of subclinical left ventricular dysfunction in postmenopausal women with rheumatoid arthritis

Abstract Aims The most frequent cause of death among patients affected by rheumatoid arthritis (RA) is heart failure, its high prevalence is independent by cardiovascular risk factors. An early diagnosis of heart failure risk may be done assessing left ventricular diastolic dysfunction (LVDD) by Doppler echocardiography. Our study aimed to estimate the LV diastolic function in RA patients. Methods and results We enrolled 207 consecutive postmenopausal women (PMW) with normal electrocardiography, physical examination, and confirmed diagnosis of RA for over a year and 200 PMW free from RA as control group (CG). All women underwent to M-mode, two-dimensional Doppler echocardiography. Seventy-two women were affected by LVDD among 207 women with RA (34.8%), 46 among 200 women on CG (23%), Chi-squared 6.8, odds ratio 1.8, confidence interval (CI) 95%, P &amp;lt; 0.0088. In our population of PMW the chance to be affected by LVDD is almost one and a half times. There were 70 women affected by LVDD among 72 hypertensive women with RA (97.2%), 32 women were affected by LVDD among 98 hypertensive women on CG (32.7%), Chi-squared 72.1, odds ratio 7.2, CI 95%, P &amp;lt; 0.0088, Table II. Among hypertensive PMW of our population the chance to be affected by LVDD is more than triple. All LVDD subjects had abnormal diastole for all different degrees of severity. Conclusions We assess that PMW affected by RA have a significantly high incidence of LV diastolic dysfunction without clinical evidence of heart disease, the incidence is even higher if they are hypertensive, so we recommend a Doppler echocardiography examination for all women with a diagnosis of RA.

The Relationship Between Resting Heart Rate and Age in Adult Nigerians

<i>Background</i>: Resting heart rate is related to cardiovascular mortality as well as to all-cause mortality. It is therefore important to know whether resting heart rate changes with age in adults. The aim of this study was to determine the relationship between heart rate and age in adult Nigerians. <i>Methods</i>: It was a retrospective study on adult Nigerians attending a University Teaching Hospital in Nigeria. All the needed data were retrieved from the medical records. Heart rate was calculated from the electrocardiogram and correlated with age. <i>Results</i>: There were 99 cases aged between 20 and 54 years and comprised of 60 males and 39 females. The mean heart rate was 73.40±13.16 beats/minute. Across the various decades, the mean heart rate in beats per minute was 73.46±10.70 in the third decade, 75.52±12.16 in the fourth decade, 72.38±13.91 in the fifth decade, and 71.60±18.77 in the sixth decade of life (p=0.770). Heart rate correlated negatively and weakly with age (r=- 0.034, p=0.736). There were more cases of sinus bradycardia than sinus tachycardia, but the proportion of cases with heart rate outside 60 beats per minute to 100 beats per minute was small. <i>Conclusion</i>: This study showed that resting heart rate did not change with age in young adult and middle-aged Nigerians who had no clinical evidence of heart disease. A greater proportion of them were in normal sinus rhythm.

The Relationship Between Resting Heart Rate and Age in Adult Nigerians

Background: Resting heart rate is related to cardiovascular mortality as well as to all-cause mortality. It is therefore important to know whether resting heart rate changes with age in adults. The aim of this study was to determine the relationship between heart rate and age in adult Nigerians. Methods: It was a retrospective study on adult Nigerians attending a University Teaching Hospital in Nigeria. All the needed data were retrieved from the medical records. Heart rate was calculated from the electrocardiogram and correlated with age. Results: There were 99 cases aged between 20 and 54 years and comprised of 60 males and 39 females. The mean heart rate was 73.40±13.16 beats/minute. Across the various decades, the mean heart rate in beats per minute was 73.46±10.70 in the third decade, 75.52±12.16 in the fourth decade, 72.38±13.91 in the fifth decade, and 71.60±18.77 in the sixth decade of life (p=0.770). Heart rate correlated negatively and weakly with age (r=- 0.034, p=0.736). There were more cases of sinus bradycardia than sinus tachycardia, but the proportion of cases with heart rate outside 60 beats per minute to 100 beats per minute was small. Conclusion: This study showed that resting heart rate did not change with age in young adult and middle-aged Nigerians who had no clinical evidence of heart disease. A greater proportion of them were in normal sinus rhythm.

1194-P: NT-proBNP, Subclinical Diastolic Dysfunction in Patients with DM Type 1 Treated with iSGLT2

Aim: Subclinical diastolic dysfuntion in patients with preclinical heart failure with preserved ejection fraction (HFpEF) has been demonstrated in patients with DM type 1. We investigated the relationship between diastolic dysfunction and NT-proBNP levels in patients with diabetes treated with iSGLT2 (dapagliflozin). Methods: NT-proBNP and diastolic function were assessed in 35 patients with DM 1 (31 ± 1,6 y, duration of DM 12,0± 1,2 y) and 15 control subjects (mean age - 29,9± 1,8years) without clinical evidence of heart disease. Data presented as M±m. The results were compared using Student’s paired test. Results: All patients had a normal ejection fraction (53,9±2,3 vs. 56,1± 4,3, (p &amp;gt; 0,05) in those with and without DM, respectively. 34,2% of the diabetic patients had evidence of diastolic dysfunction as assessed by the presence of at least two abnormal variables of mitral inflow velocity. The ratio of peak early to peak late (atrial) filling velocity was significantly decreased in diabetic compared with control subjects (E/A ratio 0,9±0,05 vs. 1,2± 0,06, p&amp;lt; 0,05), the DT was 257,1±28,2 ms vs. 186±14,6 ms p&amp;lt;0,05, in those with and without DM, respectively. Also, the IRT was increased in diabetic patients compared with control subjects (130±14,0 ms vs. 79,3±6,1 ms, p&amp;lt; 0,05). Median NT-proBNP plasma levels were elevated [189.54 pg/mL (86.16-308.27) and increased with greater severity of the diastolic dysfunction. Median NT-proBNP plasma levels have been decreased - 51.89 pg/mL (29.94-69.71); P&amp;lt;0.001] after 1 month treatment period with dapagliflozin. Conclusions: DM type 1 patients presenting with normal ejection fraction show disturbed diastolic function and higher NT-proBNP levels. 2. iSGLT2 (dapagliflozin) decreased NT-proBNP levels in DM1 patients with subclinical diastolic dysfunction. Disclosure S. Cherviakova: None. L.K. Sokolova: None. I. Belchina: None. I. Korzun: None. M.D. Tronko: None.

Usefulness of Genetic Testing in Sudden Cardiac Arrest Survivors With or Without Previous Clinical Evidence of Heart Disease

Genetic testing in survivors of sudden cardiac arrest (SCA) with a suspicious cardiac phenotype is considered clinically useful, whereas its value in the absence of phenotype is disputed. We aimed to evaluate the clinical utility of genetic testing in survivors of SCA with or without cardiac phenotype. Sixty unrelated SCA survivors (median age: 34 [interquartile range 20 to 43] years, 82% male) without coronary artery disease were included: 24 (40%) with detectable cardiac phenotype (Ph(+)SCA) after the SCA event and 36 (60%) with no clear cardiac phenotype (Ph(-)SCA). The targeted exome sequencing was performed using the TruSight-One Sequencing Panel (Illumina). Variants in 185 clinically relevant cardiac genes with minor allele frequency <1% were analyzed. A total of 32 pathogenic or likely pathogenic variants were found in 27 (45%) patients: 17 (71%) in the Ph(+)SCA group and 10 (28%) in the Ph(-)SCA group. Sixteen (67%) Ph(+)SCA patients hosted mutations congruent with the suspected phenotype, in which 12 (50%) were cardiomyopathies and 4 (17%) channelopathies. In Ph(-)SCA cases, 6 (17%) carried a mutation in cardiac ion channel genes that could explain the event. The additional 4 (11%) mutations in this group, could not explain the phenotype and require additional studies. In conclusion, cardiac genetic testing was positive in nearly 2/3 patients of the Ph(+)SCA group and in 1/6 of the Ph(-)SCA group. The test was useful in both groups to identify or confirm an inherited heart disease, with an important impact on the patient care and first-degree relatives at risk.

Coronary flow reserve in patients with primary biliary cholangitis

BackgroundIt is still not clear whether primary biliary cholangitis (PBC) is associated with abnormalities of the cardiovascular system. We aimed to assess the relationship between PBC and coronary flow reserve (CFR). MethodsOur inclusion criterion was a diagnosis of PBC with no clinical evidence of heart disease or metabolic syndrome. Coronary flow velocity in the left anterior descending coronary artery was measured using transthoracic Doppler echocardiography at rest (DFVr), and during adenosine infusion (DFVh). The corrected CFR (cCFR) was defined as the ratio of DFVh to DFVr corrected for cardiac workload (cDFVr). Microvascular resistance was also assessed in baseline (BMR) and hyperemic conditions (HMR). Results37 PBC patients and 37 sex- and age-matched controls were considered. The cCFR was significantly lower in PBC patients (2.8 ± 0.7 vs. 3.7 ± 0.7, p < 0.0001), and abnormal (≤2.5) in 13 (35%) of them, but in none of the controls (p < 0.0001). The cDFVr was higher in patients with abnormal cCFR (29.0 ± 6.0 vs. 20.4 ± 4.5 cm/sec, p < 0.0001). The CFR and cCFR did not correlate with any characteristics of PBC, comorbidities or Framingham risk scores. The BMR and HMR correlated with time since PBC diagnosis and duration of symptoms. ConclusionThe CFR is reduced in PBC, apparently due to mechanisms correlating with the time since diagnosis. In particular, the higher cDFVr with a lower basal resistance in patients with cCFR ≤ 2.5 suggests a compensatory mechanism against any cardiomyocyte bioenergetics impairment.

Evaluation of heart dysfunction in patients with rheumatoid arthritis

Cardiovascular diseases are the most common causes of death in patients diagnosed with rheumatoid arthritis (RA). The high prevalence of cardiovascular disease is independent of known risk factors in RA patients. The present study aimed to estimate the left ventricular diastolic function in patients suffering from RA using conventional Doppler and tissue Doppler echocardiographic imaging (TDI). This descriptive, cross-sectional study was conducted on 40 patients who had an established diagnosis of RA for over five years (2, 7, 9) and referred to the Rheumatology Department and Clinic of Ghaem Hospital, affiliated with Mashhad University of Medical Sciences. Patients with normal electrocardiography, chest examination, and chest radiography were subjected to M-mode, two-dimensional Doppler echocardiography. Data analysis was performed with the SPSS statistical software package (version 11.5). A p-value less than 0.05 was considered statistically significant. According to the results, mitral and tricuspid insufficiencies were the most common valvular diseases (72.5% and 52%, respectively). In 70% of the patients, diastolic function was normal. A significant relationship was observed between systolic function and diastolic abnormality (P=0.001). Pulmonary hypertension was detected in 40% of patients. Nevertheless, no significant relationship was observed between E and Em or between A and Am (P=0.432, P=0.844, respectively). The Mann-Whitney U test revealed a statistical difference between the two groups in terms of EF, which was significantly lower in the diastolic dysfunction group (P=0.047). A wide and frequent variety of cardiac diseases, especially mitral, aortic, and tricuspid regurgitation, may be found in RA patients. It can be concluded that active RA patients have a significantly high incidence of diastolic dysfunction in the absence of clinical evidence of heart disease.

Evaluation of atherosclerosis risk by measurement of intima media thickness and pulse wave velocity in lichen planus patients; A prospective case-control study

Aim: Lichen planus (LP) is one of the chronic inflammatory diseases. Chronic inflammation may play an important role in the development of subclinical atherosclerosis. In this study, we aimed to investigate the relationship between LP and atherosclerosis by using carotid intima media thickness (CIMT) and pulse wave velocity (PWV) measurements.Methods: A controlled study is designed, two groups were formed as LP and control group. Forty LP patients (32 female and 8 male; mean age 44.6±1.2 years) and 40 healthy (control) individuals (32 female and 8 male; mean age 41.2±0.9 years) enrolled in the study. Individuals with atherosclerotic risk factors were excluded from the study for both groups. Demographic and biochemical data were recorded for both groups. CIMT and PWV measurements were compared between healthy and LP patients. Results: Maximum and average CIMT values in LP patients were significantly higher than the control group (Right maximum CIMT; 0.77±0.01 vs. 0.74±0.01, p=0.01, Left maximum CIMT; 0.80±0.01 vs. 0.76±0.01, p=0.011, Right average CIMT; 0.65±0.01 vs. 0.63±0.01, p=0.039, Left average CIMT; 0.68±0.01 vs. 0.64±0.01, p=0.005, respectively). No statistically significant difference was found between LP patients and control group for PWV (6.34±0.30 vs. 6.79±0.70 respectively, p=0.131). Conclusions: Our study demonstrated that CIMT was increased in patients with LP who had no clinical evidence of heart disease. LP patients were under an increased risk of subclinical atherosclerotic vascular dysfunction and structural changes.

Prognostic significance of exercise-induced premature ventricular complexes: a systematic review and meta-analysis of observational studies

BackgroundExercise-induced premature ventricular complexes (EI-PVCs) are common during exercise stress tests. Their optimal management and prognostic significance remain uncertain.AimTo perform meta-analysis of observational studies on the prognostic significance of EI-PVCs.MethodsA...

Coronary microvascular dysfunction due to essential thrombocythemia and policythemia vera: the missing piece in the puzzle of their increased cardiovascular risk?

Myeloproliferative neoplasms are most commonly associated with venous thrombosis. Up to 60% of patients experience a thrombotic event in their lifetimes, including stroke or myocardial infarction. It is unclear whether pathogenetic factors linking essential thrombocythemia (ET) and polycythemia vera (PV) to thrombotic complications do play a role in the risk of coronary artery disease (CAD). We aimed to assess coronary flow reserve (CFR) as a marker of coronary microvascular function in asymptomatic patients with ET and PV. Fifty-two patients with ET (M/F 13/39, age 61 ± 7 years) and 22 patients with PV (M/F 13/9, age 60.4 ± 13 years) without clinical evidence of heart disease, and 50 controls matched for age and gender were studied. None had CAD. All control subjects were asymptomatic with no history of heart disease. CFR in the left anterior descending coronary artery was detected by transthoracic Doppler echocardiography, at rest, and during adenosine infusion. In patients with ET and PV, CFR was lower than in controls (2.9 ± 0.94 and 2.2 ± 0.7 vs. 3.8 ± 0.7, P < 0.004 and P < 0.0001 respectively). The prevalence of CFR ≤ 2.5 was higher in patients with ET (20 cases, 38.5%) and PV (15 cases, 68.2%) compared with controls (4.1%) (P < 0.0001). Severe CFR (CFR < 2) impairment was found in eight patients with ET (15.4%), in nine patients with PV (40.9%), and in none of control subjects. The mutation of JAK2 gene was associated with abnormal CFR. Asymptomatic patients with ET and PV have coronary microvascular dysfunction in the absence of clinical conditions suggesting CAD.

Systemic inflammation is related to coronary microvascular dysfunction in obese patients without obstructive coronary disease

Background and AimsObesity, systemic inflammation and changes in the heart functions are associated with increased cardiovascular risk. This study aimed to investigate coronary microvascular dysfunction as an early marker of atherosclerosis in obese patients without any evidence of cardiovascular disease. Methods and results86 obese subjects (aged 44 ± 12 years, body mass index (BMI) 41 ± 8 kg m−2), without evidence of heart disease, and 48 lean controls were studied using transthoracic Doppler echocardiography for detecting coronary flow reserve (CFR). A value of CFR ≤ 2.5 was considered abnormal. We measured interleukin-6 (IL-6), tumour necrosis factor-α (TNF-α) and adiponectin in all patients. Patients with abnormal CFR underwent coronary multislice computed tomography (MSCT) in order to exclude an epicardial stenosis. CFR in obese subjects was lower than in lean subjects (3.2 ± 0.8 vs. 3.7 ± 0.7, p = 0.02) and was abnormal in 27 (31%) obese patients and in one (2%) control (p < 0.0001). All subjects with abnormal CFR showed no coronary stenosis at MSCT. At multivariable analysis, IL-6 and TNF-α were the only determinants of CFR (p < 0.02 and p < 0.02, respectively). At multivariable logistic regression analysis, IL-6 and TNF-α were the only determinants of CFR ≤ 2.5 (p < 0.03 and p < 0.03, respectively). ConclusionsCFR is often reduced in obese subjects without clinical evidence of heart disease, suggesting a coronary microvascular impairment. This microvascular dysfunction seems to be related to a chronic inflammation mediated by adipocytokines. Our findings may explain the increased cardiovascular risk in obesity, independently of BMI.

Coronary microvascular dysfunction in patients with acromegaly: a hint for their increased cardiovascular risk

Purpose: Acromegaly (AC) increases the risk of cardiovascular diseases. We evaluated Coronary Flow Reserve (CFR) by Transthoracic Doppler Echocardiography (TDE), as an index of coronary microvascular function, in AC. Methods: 39 AC patients (pts) (22 M, aged 52±11 years) without clinical evidence of heart disease, and 48 controls matched for age and gender were studied. Coronary flow velocity in the left anterior descending coronary artery was detected by TDE at rest and during adenosine infusion. CFR was the ratio of hyperaemic Diastolic Flow Velocity (DFV) to resting DFV. A CFR≤2.5 was considered abnormal. The median time between the onset of symptoms and CFR assessment was 5 years (interquartile range 2-10 years). Results: In AC pts, CFR was lower than in controls (2.9±0.8 vs 3.8±0.7, p<0.0001) (Figure A). CFR was ≤2.5 in 13 (33.3%) pts compared with controls (0%) (p<0.0001). CFR was inversely related to insulin-like growth factor 1 (IGF-1) levels (Figure B). In pts with CFR≤2.5, IGF-1 was higher (756 [381-898] vs 246 [186-484] mg/L, p<0.004) while growth hormone (GH) levels were similar (6.3 [2.8-13.7] vs 5 [2.8-8.9] mg/L, p=0.8). At multivariable analysis adjusted for age, gender and other cardiovascular risk factors, IGF-1 was an independent determinant of CFR (b=-0.527, p<0.0001) and a predictor of CFR≤2.5 (p=0.01). ![Figure][1] CFR in acromegaly and relation with IGF Conclusions: Microvascular function is impaired in AC and is correlated with IGF-1 independently of GH levels, suggesting a negative effect of IGF-1 on coronary microcirculation that may contribute to the increased cardiovascular risk in AC. [1]: pending:yes

Signal-averaged and standard electrocardiography in patients with newly diagnosed epilepsy

Antiepileptic drugs (AEDs) have been associated with cardiac conduction abnormalities and arrhythmias, predominantly in patients with predisposing cardiac conditions. Ventricular late potentials (VLPs) detected in the signal-averaged electrocardiogram (SAECG) may imply an increased risk of ventricular tachycardia or fibrillation. Twenty-six AED-naïve patients with newly diagnosed epilepsy and no clinical evidence of heart disease were examined with SAECG and standard ECG. Fifteen patients were treated with lamotrigine and ten with carbamazepine. No significant abnormality was found in the standard ECG or SAECG three to nine months after initiation of AED therapy. In one patient, a VLP was detected at baseline and subsequent MRI demonstrated significant right ventricular pathology; therefore, this patient was excluded from the rest of the study. This exclusion along with only newly diagnosed patients with a low total seizure count being included in the study may explain the lack of AED-induced electrocardiographic abnormalities in this patient cohort.

Holiday Heart Syndrome

Holiday heart syndrome is an acute cardiac rhythm or conduction disturbance associated with heavy ethanol consumption in a person without other clinical evidence of heart disease. Typically, this resolves rapidly with spontaneous recovery during subsequent abstinence from alcohol use. Two adolescents were presented with different degrees of heart block following acute alcohol ingestion. The electrocardiograph abnormalities resolved within 12 hours. Further investigations, including echocardiography and 24-hour electrocardiograph, were normal. Emergency Department physicians should be aware of the possibility of acute alcohol ingestion causing changes in cardiac conduction which has a potential to develop into life-threatening arrhythmias, thus, can occur in children and young adolescents.

Holiday Heart Syndrome

Holiday heart syndrome is an acute cardiac rhythm or conduction disturbance associated with heavy ethanol consumption in a person without other clinical evidence of heart disease. Typically, this resolves rapidly with spontaneous recovery during subsequent abstinence from alcohol use. Two adolescents were presented with different degrees of heart block following acute alcohol ingestion. The electrocardiograph abnormalities resolved within 12 hours. Further investigations, including echocardiography and 24-hour electrocardiograph, were normal. Emergency Department physicians should be aware of the possibility of acute alcohol ingestion causing changes in cardiac conduction which has a potential to develop into life-threatening arrhythmias, thus, can occur in children and young adolescents.

Assessment of cardiac involvement in sarcoidosis by echocardiography

The main objective of this study is to determine the prevalence of left ventricular systolic and diastolic dysfunction in patients with chronic sarcoidosis without clinical evidence of heart disease. The study includes 69 chronic sarcoidosis patients, 30 diagnosed by organ biopsy and 39 by clinical history, chest X-ray, high resolution computerized tomography (HRCT) and bronchoalveolar lavage (BAL), without suspected cardiac involvement. The control group consisted of 26 subjects selected from a population of hospital workers. The examination includes 12-lead ECG and echocardiographic examination. The results show that there were no differences in atrial size, left ventricular diameters, wall thickness, left ventricular ejection fraction or endocardial fractional shortening between the sarcoid group and controls. Signs of diastolic dysfunction were found in 33 (55%) patients, however, this group was significantly older than the others and had marginally higher blood pressure. Sarcoid patients had lower midwall fractional shortening (mFS) than controls; patients with diastolic dysfunction also had lower mFS but the difference was not significant. In conclusion, the results demonstrated an absence of left ventricular systolic dysfunction, evaluated by traditional echocardiographic methods, in our chronic sarcoidosis patients and an apparent absence of any relation between left ventricular diastolic dysfunction and sarcoidosis. Lower mFS was found among patients, particularly those with a long history of sarcoidosis. Further analysis is required to evaluate the significance of this index as a potential marker of heart involvement in chronic sarcoidosis.

Is There Any Relationship between Metabolic Parameters and Left Ventricular Functions in Type 2 Diabetic Patients without Evident Heart Disease?

The aim of the present study was to evaluate left ventricle (LV) systolic and diastolic function, using tissue Doppler echocardiography (TDE) and color M-mode flow propagation velocity, in relation to blood glucose status in normotensive patients with type 2 diabetes mellitus (T2DM) who had no clinical evidence of heart disease. Seventy-two patients with T2DM (mean age 49.1 +/- 9.8 years) without symptoms, signs or history of heart disease and hypertension, and 50 ages matched healthy controls (mean age 46.1 +/- 9.8 years) had echocardiography. Systolic and diastolic LV functions were detected by using conventional echocardiography, TDE and mitral color M-mode flow propagation velocity (V(E)). Fasting blood glucose level (FBG) after 8 hours since eating a meal, postprandial blood glucose level (PPG), and HbA(1C) level were determined. The association of FBG, PPG and HbA(1C) with the echocardiographic parameters was investigated. It was detected that although systolic functions of two groups were similar, diastolic functions were significantly impaired in diabetics. No relation of FBG and PPG with systolic and diastolic functions was determined. However, HbA(1C) was found to be related to diastolic parameters such as E/A, Em/Am, V(E) and E/V(E) (beta=-0.314, P = < 0.05; beta=-0.230, P < 0.05; beta=-0.602, P < 0.001, beta= 0.387, P < 0.005, respectively). In addition to HbA(1C), LV, diastolic functions were also correlated with age and diabetes duration. Diastolic LV dysfunction may develop even in absence of ischemia, hypertension, and LVH in T2DM. FBG and PPG have no effect on LV functions, but HbA(1C) levels may affect diastolic parameters.

Preclinical Impairment of Coronary Flow Reserve in Patients with Rheumatoid Arthritis

Cardiovascular involvement in rheumatoid arthritis (RA) is common, although the true prevalence of cardiac abnormalities is difficult to measure, as much disease remains clinically silent. The pathogenesis of cardiac lesions in RA is related to the primary disorder of microcirculation with diffuse arteriolar and capillary lesions. Previous studies demonstrated that coronary flow reserve (CFR) is impaired in patients with connective tissue diseases (CTD). This review focuses on transthoracic Doppler echocardiography as a noninvasive method used to assess CFR in RA patients. CFR is early reduced in RA patients without clinical evidence of heart disease as a result of impaired microcirculation. CFR seems a useful technique able to follow-up and to assess effects of new drugs on RA patients.

Evidence of Left Ventricular Contractile Asynchrony by Echocardiographic Phase Imaging in Patients With Type 2 Diabetes Mellitus and Without Clinically Evident Heart Disease

Left ventricular electromechanical asynchrony has been shown to predict cardiac events in patients with heart failure. This study investigated whether left ventricular asynchrony is present in patients with type 2 diabetes mellitus (DM) with no clinically evident heart disease and normal QRS durations. Asynchrony was evaluated in 24 patients with DM, 15 nondiabetic control subjects, and 20 patients with left bundle branch block (LBBB) due to cardiomyopathy serving as positive controls by conventional tissue Doppler imaging and by a novel method, echocardiographic phase imaging. Asynchrony was significantly higher in patients with DM than in controls and significantly lower than in patients with LBBB. This was shown by tissue Doppler imaging: the SD of time to peak myocardial velocity was 13 +/- 10 ms in controls, compared with 30 +/- 19 ms in patients with DM (p <0.01) and 68 +/- 28 ms in those with LBBB (p <0.001). Similar data were obtained using echocardiographic phase imaging: the SD of phase degrees was 25 degrees +/- 8 degrees in controls, compared with 44 degrees +/- 21 degrees in patients with DM (p = 0.02) and 76 degrees +/- 25 degrees in those with LBBB (p <0.001). Tissue Doppler imaging correlated with echocardiographic phase imaging (r = 0.79, p <0.0001) but was more time consuming (15.5 +/- 4.5 vs 4.5 +/- 2.2 min/patient, p <0.05) and showed higher intraobserver variability (5.6% vs 3.2%, p <0.05). In conclusion, this is the first study showing increased left ventricular asynchrony in patients with DM and no clinical evidence of heart disease.